Effective January 1st, 2014, the California Division of Workers’ Compensation (DWC) adapted Medicare CPT/HCPCS Status Codes to further provide reimbursement information for various Procedure Codes.
Section 9789.12.3 mandates specific guidelines for status codes C, I, N, and R.
For C, N, and R Status Codes:
- Use the CMS Relative Value Units (RVUs) to calculate reimbursements.
- When there is no RVU assigned, services are reimbursed By Report.
For I Status Codes:
- The service or product is reimbursed according to the CPT code.
- If an HPCPCS “J” code is used, the code is reimbursed according to section 9789.13.2.
If the above is nonapplicable:
- Use the RVUs to calculate reimbursements.
- If the above is not applicable, refer to the regulations in sections 9789.30 - 9789.70.
- If both of the above are not applicable, the code is payable By Report.
California Code of Regulations (CCR)
Division of Workers’ Compensation Websites
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